Wednesday, November 05, 2008

Vulnerability Index

Janus Youth Programs recently collaborated with Portland’s Bureau of Housing and Community Development, New York City's Common Ground Institute, local service providers, and nearly 70 volunteers to conduct a Vulnerability Index survey in our community. The Vulnerability Index is a tool for identifying and prioritizing a community's most medically fragile homeless population. It is a practical application of research into the causes of death of homeless individuals initially conducted by Boston’s Healthcare for the Homeless organization, led by Dr. Jim O’Connell. The Boston research identified specific health conditions that cause homeless individuals to be most at risk for dying on the street. The Vulnerability Index is administered in the form of a survey, which captures a homeless individual’s health and institutional history. The survey identifies vulnerability through a ranking system which takes into account risk factors and the duration of homelessness. This ranking allows those with the most severe health risks to be identified and prioritized for housing and other support. By surveying people who are living on our streets here in Portland, we now have clear health and housing data on the individuals living on the streets and in some of our community’s shelters. This data will hopefully allow Portland to take immediate action on behalf of the most vulnerable people who are living on our streets, as well as identifying and implementing system improvements. 13 teams strategically canvassed Portland between the hours of 6am and 8am over the course of 3 mornings beginning on Tuesday October 21. The initial findings were decidedly disturbing. 646 people were surveyed and 47% of those fit the definition of "medically vulnerable". In comparison with other communities that conducted the Vulnerability Index survey, Portland stands out in several areas:

• Portland’s overall “medically vulnerable” population was 5% higher than other cities that conducted the same survey (notably New York City, Los Angeles County's Skid Row, Santa Monica, New Orleans and Washington D.C.).

• Portland surveyed more young adults sleeping on the streets than other cities (15 people surveyed were under the age of 19 and 89 people surveyed were under the age of 30). 23 people under the age of 25 fit the survey's definition of "medically vulnerable" (specifically related to co-existing HIV, injection drug use and or daily alcohol consumption), a much higher number of young adults that fit the risk criteria than the larger cities that conducted the survey.

• Portland had a 12% higher rate of tri-morbidity than other cities that conducted the same survey. Tri-morbidity is defined as a co-occurring psychiatric, substance abuse, and chronic medical condition.

• Shockingly, Portland had a 10% higher rate of violent attacks on homeless than other cities that conducted the same survey (keep in mind again that those other cities include New York City, Los Angeles County's Skid Row, Santa Monica, New Orleans and Washington D.C.)

• 29% of the homeless people surveyed said they had foster care involvement at some point during their lives, 3 times higher than the national average (the average for the other cities that conducted the Vulnerability Index was about 10%).

• Despite our relatively mild winters Portland has a significantly higher rate of exposure-related health risks such as frostbite, hypothermia, and immersion foot(trench foot). Exposure-related health risks are considered indicators of self-neglect and Portland's rates are alarmingly close to New York City.

• Portland has a much higher percentage of people whose only income is food stamps and a higher rate of folks without healthcare (63% of the people surveyed had no insurance).

• Those surveyed reported a total of 730 emergency room visits within the past 3 months at an estimated cost of $492 per visit for an estimated cost of $1.43 million per year in emergency medical care.